Management of dural arteriovenous malformations of the anterior cranial fossa

Abstract

Eight patients with dural arteriovenous malformations (AVM's) of the anterior cranial fossa are presented, and the pertinent literature is reviewed. Unlike cases of dural AVM's in other locations, sudden massive intracerebral hemorrhage was the most frequent reason for presentation. Other symptoms included tinnitus, retro-orbital headache, and a generalized seizure. The malformations were supplied consistently by the anterior ethmoidal artery, usually in combination with other less prominent feeding vessels. The lesion's venous drainage was through the superior sagittal sinus via a cortical vein; in addition, in two cases a subfrontal vein drained the AVM. A venous aneurysm was encountered near the site of anastomosis with the dural feeder in most cases, and was found in all patients who presented with hemorrhage. The AVM was obliterated surgically in six patients, with favorable results achieved in five. One patient died postoperatively from a pulmonary complication. Because of their anatomy and proclivity for hemorrhage, these vascular malformations represent a unique group of dural AVM's. Surgical management of anterior fossa dural AVM's carries low morbidity, and is indicated when the lesions have caused hemorrhage or when there is an associated venous aneurysm.

Dural Arteriovenous Fistula in the Anterior Cranial Fossa -Four Case Reports-

“…1,4,5,7,8,[13][14][15][16] Direct drainage into the subfrontal cortical veins causes intracranial venous hypertension associated with a high incidence of intracranial hemorrhage and other clinical symptoms such as headache, seizure, and visual loss. 4) Evaluation of the intracranial venous hypertension is essential for deciding on the method of treatment for asymptomatic or nonruptured DAVF.…”

“…1,4,5,8,[13][14][15] Transarterial embolization is possible but not common because of the difficulty in catheterizing small vessels and the high risk of visual compromise due to occlusion of the retinal branches. 1,5,7,8,13) Transvenous embolization using coils has potential, as this technique supports the navigation of a microcatheter through the frontal bridging vein tortuosities, enabling the detection of the exact location of the fistula.…”

Ruptured Anterior Communicating Artery Aneurysm Associated With Anterior Cranial Fossa Dural Arteriovenous Fistula -Case Report-

“…Concurrent surgery was performed in only one 17) of 6 cases presenting as non-hemorrhagic episodes (Table 2). 9,11,13,17) Since both surgeries are considered to be major, there may be some reluctance to undertake combined procedures. However, only disconnection of the fistula with coagulation is sufficient for anterior cranial fossa dural AVF, 1,3,13) and the surgical results are usually satisfactory.…”

“…9,11,13,17) Since both surgeries are considered to be major, there may be some reluctance to undertake combined procedures. However, only disconnection of the fistula with coagulation is sufficient for anterior cranial fossa dural AVF, 1,3,13) and the surgical results are usually satisfactory. 1,5,7,10,11) Although the approach side for the aneurysm can be contralateral to the main location of the dural AVF, anterior cranial fossa dural AVF can be treated, in most cases, only with intradural exposure of bilateral cribriform plates.…”

“…Dural arteriovenous fistula (AVF) of the anterior cranial fossa is relatively rare, accounting for less than 10% of all dural AVF, 7,13) but several reviews 5,7,10,11,19) and a clinical study of 24 cases 1) have suggested a distinct subgroup due to the typical features including strong male predominance and high rate of hemorrhage. Hemorrhagic episodes in dural AVF are believed to result from disruption of the cortical or pial drainage vein.…”